HomeMy WebLinkAboutPermit Mechanical 2003-01-27Gity of Springfield
Mechanical Permit
Status: Issued
225 Fifth Street
Springfield Oregon 97 477
541-726-37 59 Phone
541-726-3676Fax
541-7 26-37 69 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
MEC2003-00003
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SITE ADDRESS:
ASSESSOR'S PARCELNO.:
PROJECT DESCRIPTION:
2420 37TH Springfield
TYPE OF WORK:
TYPE OF USE:
associated piping
New
Residential
.arb
OWNERY .v
RODNEY OLSEN
242037THST
SPRINGFIELDOR9T4TT .1-}
U:. MECHAMCAL CONTRACTOR:
KEITH LEESMAN 541-995-6157
835 N BTH ST
HARRISBURG OR 97446
CCB # 72082 Expiration Date: 0410412003
Description
+ l0%o Administrative Fee
+ 7o/o State Surcharge
-Issuance Fee-
Appliance Vent
Gas Fireplace
Gas Outlets l-4
Minimum/Adiustments -
Amount Paid
4.s0
3.15
10.00
\$
\t
Receint Number
1200200000000000609
1200200000000000609
1200200000000000609
1200200000000000609
1200200000000000609
1200200000000000609
1200200000000000609
0t/27t2003
0U27t2003
01/2712003
To Request an inspection at7264769. All inspections requested before 7:00 a-m. willbe made
the same working day, insp stod after 7:00 a-m. will be made the following working day.
Required Inspections:
By Signature, I state and agree, that I have carefrrlly examined the completed application and do hereby certiff that all
information hereon is true and correct, and I frlther certify that any and all work puformed shall be done in accordance with
the Ordinances of the City of Springfield and the laws of the State of Orcgon pertaining to the work described herein. I
further certi$ ttrat only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I
further agree to ensure that all required inspections are requestd at the proper time, that each address is readable from the
street, and that the approved set ofplans, if applicable, will remain on the site at all times during construction
Owner or Contactors
lofl
Date
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City of Springfietd
Development Services Department
Public Works Department
Official Receipt
225 Fifth Street
Springfield, Oregon 97 477
541:726-3759 Phone
Receipt #z 1200200000000000609
Date: 0112712003
Line ltems:
JoUJournal Number Description Amount Paid
MEC2003-00003
MEC2003-00003
MEC2003-00003
MEC2003-00003
MEC2003-00003
MEC2003-00003
MEC2003-00003
Appliance Vent
Gas Outlets l-4
Gas Fireplace
Minimum/Adj ustments - Mech
-Issuance Fee-
+ 7Yo State Surcharge
+ lloh Administrative Fee
Payments
6.00
4.00
15.00
20.00
10.00
3.l5
4.50
Line Item Total:$62.6s (
Tlpe of Payment Paid By Received By Check Number Conlirm No How Received Amount Paid
Check RODNEY OLSEN djb In Person 62.65
Total:$62.6s
Page I of I cR€ceipt.rpt